Pediatric lupus nephritis

　　The etiology of lupus nephritis has not been elucidated. Most scholars believe that this disease is an individual with certain genetic characteristics, which causes autoimmune injury due to immune disorder under the action of various triggering factors (such as infection, physical and chemical environmental factors). The specific pathogenic factors mainly include the following:

　　One, Genetic Factors

　　Epidemiological data on genetic factors show that this disease has a familial aggregation tendency, with a prevalence rate of 25% to 70% in monozygotic twins, which is significantly higher than that in dizygotic twins.

　　Two, Environmental and Infection Factors

　　1, Ultraviolet: Ultraviolet light is considered one of the causes of lupus nephritis.

　　2, Drugs or Chemical Substances: Some drugs can induce the production of autoantibodies, such as procainamide, hydralazine, etc.; some spices, dyes, hair dyes, smoked food, and fungi can also induce lupus nephritis.

　　3, Infection: Recent data has found that HIV-infected individuals can develop lupus nephritis. The serum of patients with this disease commonly shows an increase in various viral antibody titers (such as rubella, influenza, measles, etc.).

　　Three, Endocrine Factors

　　Lupus nephritis patients are mostly female, and the estrogen levels of both male and female patients are increased, while androgen levels are decreased.

　　Pediatric lupus nephritis often complicates renal failure, hypertension, epilepsy, hemiplegia, multiple peripheral neuritis, retinitis, peritonitis, pleurisy, pneumonia, pulmonary hemorrhage, intestinal necrosis and perforation, pericarditis, myocarditis, and other diseases.

　　Lupus nephritis is very common in lupus disease and is a key factor threatening the quality of life in the long term. The clinical manifestations of lupus nephritis mainly include the following forms.

　　1, Mild: About 30% to 50% of lupus nephritis children show this type, without edema, without hypertension, only with mild to moderate proteinuria (often

　　2, Chronic nephritis type: Children have varying degrees of renal insufficiency and hypertension.

　　3, Acute nephritis or rapidly progressive nephritis syndrome: 35% to 50% of patients have hypertension, varying degrees of proteinuria. There are more red cell casts in the urine sediment. Renal insufficiency or failure. The onset of acute nephritis is similar to post-streptococcal acute nephritis. Children may have oliguria or anuria. The onset of rapidly progressive nephritis is similar to other rapidly progressive nephritis, manifested as an acute progressive oliguric acute renal failure.

　　4, Nephrotic syndrome: 40% of patients can present with simple nephrotic syndrome or nephrotic syndrome with a marked nephritis syndrome.

　　5, Renal tubular damage type: Renal tubular acidosis with renal calcification, stones, and urinary magnesium loss.

　　When preventing pediatric lupus nephritis, attention should be paid to avoiding precipitating factors. Avoid sun exposure, ultraviolet radiation, and avoid cold stimulation. Avoid taking drugs that induce lupus disease and drugs that are harmful to the kidneys. Participate in physical activities appropriately to enhance physical fitness, which is beneficial for the prevention of this disease.

　　When diagnosing pediatric lupus nephritis, in addition to the patient's facial features, reliance is mainly placed on various examination methods. The commonly used examination methods are as follows:

　　One, Urine examination

　　Children with lupus nephritis may have proteinuria and hematuria.

　　Two, Blood examination

　　Most children with lupus nephritis have varying degrees of anemia. Some children have a decrease in white blood cells and platelets. More than 90% of patients have a marked increase in erythrocyte sedimentation rate, a decrease in blood albumin, but an increase in globulin.

　　Three, Immunological examination

　　Immunological examination mainly checks antinuclear antibodies, anti-double-stranded DNA (dsDNA) antibodies, and circulating immune complexes.

　　Four, Renal biopsy examination

　　Renal biopsy examination has a 100% diagnostic rate for systemic lupus erythematosus. Even if there are no renal abnormalities in clinical practice, renal biopsy will show abnormalities.

　　Five, Ultrasound examination

　　Ultrasound has significant guiding significance for renal lesions in patients with systemic lupus erythematosus.

　　Dietary adjustment for children with lupus nephritis is particularly important for the prognosis and outcome of the disease, and it should be paid attention to by patients. The following points should be noted in the diet for lupus nephritis:

　　1. Avoid or eat less food that enhances photosensitivity.Avoid sunlight exposure after eating. Fungi such as mushrooms and shiitake, as well as certain food dyes and tobacco, can also trigger lupus nephritis, so try to avoid eating them or eat them in small amounts.

　　2, Eat more high-protein foods.Patients with systemic lupus erythematosus nephritis with kidney damage often have a large amount of protein lost in urine, which can cause hypoproteinemia. Therefore, it is necessary to supplement sufficient high-quality protein. Eggs, lean meat, fish, milk, and soy products are rich in protein, and can be eaten more in daily life.

　　3, Low-fat, low-sugar, low-salt diet.Patients with systemic lupus erythematosus nephritis have less activity and poor digestive function, and should eat light and easily digestible foods, not foods rich in fat. Patients who have long-term taken corticosteroids are prone to steroid-induced diabetes and Cushing's syndrome, so it is necessary to control the amount of food appropriately and eat less food with a high sugar content. Patients with corticosteroid use or kidney damage are prone to water and sodium retention, causing edema, so a low-salt diet should be maintained.

　　Lupus nephritis in children emphasizes individualized treatment. During treatment, timely intervention should be made for complications such as heart, kidney, and nervous system, and the advantages and disadvantages of drug treatment should be fully considered. The main treatment methods include the following aspects:

　　First, General Treatment

　　During the acute and active phases, children should strengthen their nutrition and avoid sunlight at the same time; gradually resume activities and school during the stationary phase. During the period of taking immunosuppressants, try to avoid public places to reduce the chance of infection. If infection occurs, it should be treated actively. It is necessary to avoid using commonly used drugs that induce lupus and kidney damage (sulfonamides, hydralazine, procainamide, para-aminosalicylic acid, penicillin, aminoglycoside drugs).

　　Second, Immunosuppressants

　　1, Glucocorticoids：Glucocorticoids have a strong anti-inflammatory effect and are the basic drugs for the treatment of lupus.

　　2, Cytotoxic drugs：Combining corticosteroids with cytotoxic drugs for the treatment of lupus nephritis is much more effective than using corticosteroids alone or cytotoxic drugs alone. The combination of drugs can also greatly reduce the dosage of corticosteroids used, improving efficacy.

　　Three, Anticoagulants

　　Patients with lupus nephritis often present with a hypercoagulable state, especially after the use of adrenal cortical hormones. Platelet aggregation is enhanced, and blood fibrinogen levels increase, which not only can lead to glomerular capillary thrombosis but also easily cause thrombosis in large blood vessels such as renal veins. Anticoagulation therapy should be administered.